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2018年AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNAの血液コレステロール管理に関するガイドラインの体系的レビュー: アメリカン・カレッジ・オブ・カーディオロジー/アメリカン・ハート・アソシエーションの臨床実践ガイドラインに関するタスクフォースの報告書
Peter W F Wilson, Tamar S Polonsky, Michael D Miedema
Circulation
|December 28, 2018
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PubMed で要約を見る
まとめ
エゼチミブやPCSK9阻害剤のような非スタチン脂質調節療法をスタチンに追加すると,動脈硬化性心血管疾患 (ASCVD) の発生を減少させることができます. このレビューでは,ナイアシンとコレステロールエステル移転タンパク質阻害剤の有意な効果は示されなかった.
科学分野:
- 心臓病科
- 薬理学について
- 予防 医療
背景:
- 2013年のACC/AHAのガイドラインでは,非スタチンの脂質調節薬が動脈硬化性心血管疾患 (ASCVD) の発生を減少させるという限られた証拠が示された.
- その後,ランダム化対照試験 (RCT) が発表され,これらの治療法の最新評価が必要となった.
研究 の 目的:
- スタチン以外の脂質調節療法が,ASCVDのリスクを減らすためにスタチンに添加されたときの利益と害を体系的に検討する.
- 既定のASCVDまたは高いASCVDリスクを有する患者において,これらの追加療法とスタチンを比較する.
主な方法:
- > 1,000人の患者と > 1年間のフォローアップによるRCTのシステマティックレビュー
- エゼチミブ,ニアシン,コレステロールエステル移転タンパク質 (CETP) 阻害剤,PCSK9阻害剤を評価した試験も含まれていた.
- 主要アウトカム: 致死性心血管疾患,非致死性心筋梗塞,非致死性脳卒中の複合.
主要な成果:
- エゼチミブと2つのPCSK9阻害剤はASCVDの罹患率を低下させた.
- 1つのPCSK9阻害剤はASCVDの死亡率を低下させた.
- エゼチミブ/ シムバスタチン,エヴォロキュマブ,アリロキュマブは,主治体的なアウトカムに有意な減少を示したが,有害事象は増加しなかった.
- CETP阻害剤はASCVDのリスクや有害事象の利益が最小限であり,ニアシンは追加の利益をもたらさなかった.
結論:
- エゼチミブとPCSK9阻害剤は,ASCVDのリスクを減らすためにスタチン療法に追加された場合,心血管上の利点を提供します.
- ナイアシンとCETP阻害剤は,レビューされた試験では有意な効果を示さなかった.
- 更に直接的な比較は試験の異質性によって制限されます.
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